1
|
Wei X, Zhu W, Li J, Zhou S, Zhu Q, Ma X, Han Y, Wang Y, Miao M, Qiu H, Wu D, Wu X. The Role of Pre-existing Anti-HLA Antibodies in Severe Aplastic Anemia Patients Undergoing Allogenic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2024; 30:902.e1-902.e11. [PMID: 38740139 DOI: 10.1016/j.jtct.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
The objective is to underscore the significance of pre-existing anti-HLA Abs in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for SAA. A retrospective analysis was conducted using data from 244 SAA patients who underwent allo-HSCT between January 2016 and October 2022. The patient cohort was divided into 2 groups based on the presence of pre-existing anti-HLA Abs. Out of 244 SAA patients, 82 were tested positive for anti-HLA Abs. Seventeen patients were tested with DSA in haplo-HSCT. We found that the presence of pre-existing anti-HLA Abs did not influence neutrophil engraftment (P = .600); however, it resulted in delayed platelet recovery (P = .006). Comparatively, patients with anti-HLA Abs demonstrated lower overall survival (OS) compared to their counter parts without anti-HLA Abs (P = .001), with a correspondingly elevated transplant-related mortality (TRM) in the former group (P = .002). Multivariate analysis established pre-existing anti-HLA Abs as an independent risk factor for impaired platelet recovery (HR 1.67, 95% CI 1.16 to 2.44, P = .006) and OS (HR 2.19, 95% CI 1.03 to 4.67, P = .043). However, there were no differences between DSA and non-DSA patients after desensitization in haplo-HSCT. In summary, the presence of pre-existing anti-HLA Abs in SAA patients undergoing allo-HSCT appears to detrimentally affect platelet recovery and overall prognosis.
Collapse
Affiliation(s)
- Xiya Wei
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Wenjuan Zhu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jing Li
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Shiyuan Zhou
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Qian Zhu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiao Ma
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yue Han
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Ying Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Miao Miao
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaojin Wu
- The First Affiliated Hospital of Soochow University, Suzhou, China; National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, Suzhou, China; Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
| |
Collapse
|
2
|
Panch SR, Guo L, Vassallo R. Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management. Blood Rev 2023; 62:101135. [PMID: 37805287 DOI: 10.1016/j.blre.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Platelet transfusion refractoriness due to HLA alloimmunization presents a significant medical problem, particularly among multiply transfused patients with hematologic malignancies and those undergoing hematopoietic stem cell transplants. HLA compatible platelet transfusions also impose significant financial burden on these patients. Recently, several novel mechanisms have been described in the development of HLA alloimmunization and platelet transfusion refractoriness. We review the history of platelet transfusions and mechanisms of HLA-sensitization and transfusion refractoriness. We also summarize advances in the diagnosis and treatment of platelet transfusion refractoriness due to HLA alloimmunization.
Collapse
Affiliation(s)
- Sandhya R Panch
- Clinical Research Division, Fred Hutchinson Cancer Center, United States of America; BloodWorks NorthWest, United States of America.
| | - Li Guo
- BloodWorks NorthWest, United States of America; Division of Hematology and Oncology, University of Washington School of Medicine, United States of America
| | | |
Collapse
|
3
|
Liang L, Li N, Wang Y, Luo S, Song Y, Fang B. Human leukocyte antigen-DRB1 gene polymorphism and aplastic anemia: A meta-analysis. Medicine (Baltimore) 2023; 102:e33513. [PMID: 37335708 DOI: 10.1097/md.0000000000033513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The human leukocyte antigen-DRB1 (HLA-DRB1) gene plays key roles in mediating immune response and activating autoreactive T-cells during aplastic anemia (AA) etiology. However, inconsistency appeared in the associations between HLA-DRB1 polymorphism and AA. We aimed to comprehensively clarify their associations in the meta-analysis. METHODS PubMed, Embase, Web of Science, Science Direct, SinoMed, WanFang Data, China National Knowledge Infrastructure, and Chongqing VIP Chinese Science Database were searched from January 2000 to June 2022. Statistical analysis was performed in STATA 15.0 and Comprehensive Meta-analysis Software 3.0. RESULTS A total of 16 studies with 4428 patients were eventually analyzed. The results of the meta-analysis suggested that HLA-DRB1*0301 could decrease the risk of AA (odd ratio (OR) = 0.600, 95% CI: 0.427, 0.843). Besides, HLA-DRB1*0901 and HLA-DRB1*1501 were risk factors of AA (OR = 1.591, 95% CI: 1.045, 2.424; OR = 2.145, 95% CI: 1.501, 3.063; respectively). Sensitivity analysis showed heterogeneity among included studies. CONCLUSION HLA-DRB1 polymorphisms could play roles in the occurrence of AA, however more population-based studies with larger sample sizes are required to certify our findings.
Collapse
Affiliation(s)
- Lijie Liang
- Henan Institute of Hematology, Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ning Li
- Department of Oncology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yaomei Wang
- Henan Institute of Hematology, Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Suxia Luo
- Department of Oncology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yongping Song
- Henan Institute of Hematology, Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Baijun Fang
- Henan Institute of Hematology, Department of Hematology, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| |
Collapse
|
4
|
Chiueh TS, Wang HY, Wu MH, Hsueh YS, Chen HC. Evaluation of Platelet Alloimmunization by Filtration Enzyme-Linked Immunosorbent Assay. Diagnostics (Basel) 2023; 13:diagnostics13101704. [PMID: 37238189 DOI: 10.3390/diagnostics13101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
The current methods for detecting antiplatelet antibodies are mostly manual and labor-intensive. A convenient and rapid detection method is required for effectively detecting alloimmunization during platelet transfusion. In our study, to detect antiplatelet antibodies, positive and negative sera of random-donor antiplatelet antibodies were collected after completing a routine solid-phase red cell adherence test (SPRCA). Platelet concentrates from our random volunteer donors were also prepared using the ZZAP method and then used in a faster, significantly less labor-intensive process, a filtration enzyme-linked immunosorbent assay (fELISA), for detecting antibodies against platelet surface antigens. All fELISA chromogen intensities were processed using ImageJ software. By dividing the final chromogen intensity of each test serum with the background chromogen intensity of whole platelets, the reactivity ratios of fELISA can be used to differentiate positive SPRCA sera from negative sera. A sensitivity of 93.9% and a specificity of 93.3% were obtained for 50 μL of sera using fELISA. The area under the ROC curve reached 0.96 when comparing fELISA with the SPRCA test. We have successfully developed a rapid fELISA method for detecting antiplatelet antibodies.
Collapse
Affiliation(s)
- Tzong-Shi Chiueh
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan, China
- School of Medicine, Chang Gung University, Taoyuan City 333, Taiwan, China
| | - Hsin-Yao Wang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan, China
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan City 333, Taiwan, China
| | - Min-Hsien Wu
- Graduate Institute of Biochemical and Biomedical Engineering, Chang Gung University, Taoyuan City 333, Taiwan, China
| | - Yu-Shan Hsueh
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan, China
| | - Hui-Chu Chen
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan, China
| |
Collapse
|
5
|
Couvidou A, Rojas-Jiménez G, Dupuis A, Maître B. Anti-HLA Class I alloantibodies in platelet transfusion refractoriness: From mechanisms and determinants to therapeutic prospects. Front Immunol 2023; 14:1125367. [PMID: 36845153 PMCID: PMC9947338 DOI: 10.3389/fimmu.2023.1125367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
Patients with hematological disorders and severe thrombocytopenia require extensive and iterative platelet transfusion support. In these patients, platelet transfusion refractoriness represents a serious adverse transfusion event with major outcomes for patient care. Recipient alloantibodies against the donor HLA Class I antigens expressed at the cell surface of platelets result in a rapid removal of transfused platelets from the circulation and thus, therapeutic and prophylactic transfusion failure leading to a major bleeding risk. In this case, the only way to support the patient relies on the selection of HLA Class I compatible platelets, an approach restricted by the limited number of HLA-typed donors available and the difficulty of meeting the demand in an emergency. However, not all patients with anti-HLA Class I antibodies develop refractoriness to platelet transfusions, raising the question of the intrinsic characteristics of the antibodies and the immune-mediated mechanisms of platelet clearance associated with a refractory state. In this review, we examine the current challenges in platelet transfusion refractoriness and detail the key features of the antibodies involved that should be considered. Finally, we also provide an overview of future therapeutic strategies.
Collapse
Affiliation(s)
- Adèle Couvidou
- UMR_S1255, INSERM, Strasbourg, France
- Etablissement Français du Sang-Grand Est, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Gabriel Rojas-Jiménez
- UMR_S1255, INSERM, Strasbourg, France
- Etablissement Français du Sang-Grand Est, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Arnaud Dupuis
- UMR_S1255, INSERM, Strasbourg, France
- Etablissement Français du Sang-Grand Est, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Blandine Maître
- UMR_S1255, INSERM, Strasbourg, France
- Etablissement Français du Sang-Grand Est, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| |
Collapse
|
6
|
Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study. Crit Care Res Pract 2021; 2021:5589768. [PMID: 34603795 PMCID: PMC8486553 DOI: 10.1155/2021/5589768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/03/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). Methods A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 106/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (p = 0.02), but not with mortality. Conclusions Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.
Collapse
|
7
|
Julen K, Volken T, Holbro A, Infanti L, Halter JP, Schaub S, Wehmeier C, Diesch T, Rovó A, Passweg JR, Buser A, Drexler B. Transfusions in Aplastic Anemia Patients Cause HLA Alloimmunization: Comparisons of Current and Past Cohorts Demonstrate Progress. Transplant Cell Ther 2021; 27:939.e1-939.e8. [PMID: 34314891 DOI: 10.1016/j.jtct.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Transfusions are the mainstay of supportive therapy in patients with aplastic anemia (AA) and may lead to anti- HLA alloimmunization, thereby also increasing the risk for donor-specific antibodies in the setting of HLA-mismatched transplantation. Historically, AA patients were thought to be at particularly high risk for HLA alloimmunization. In past decades, blood product manufacturing (leukoreduction) and HLA antibody testing have improved significantly by single antigen bead (SAB) technology. It is currently unknown how those developments have impacted HLA alloimmunization and treatment outcome in patients with AA. We retrospectively investigated 54 AA patients treated by immunosuppressive therapy or allogeneic hematopoietic cell transplantation after the introduction of the SAB assay at our center. We compared the HLA antibody results to a historical AA cohort (n = 26), treated before introduction of leukoreduced blood products from 1975 to 1995. HLA alloimmunization was detected in 43 of 54 (80%) recently treated patients. Past pregnancy, female gender, disease severity, age, and a history of other transfusions were significantly associated with a larger number or higher intensity (mean fluorescence intensity) of HLA antibodies. Treatment outcome including bleeding episodes, response to treatment, engraftment, graft-versus-host disease, and overall survival was not associated with HLA alloimmunization. In the historical cohort a significantly higher number of HLA antibodies (P < .01) with a higher mean fluorescent intensity (P < .01) was observed. HLA alloimmunization remains frequent in AA tested by current techniques, but it has significantly decreased since prior decades and does not affect treatment outcome. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Katja Julen
- Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland; Division of Hematology, University Hospital Basel, Switzerland
| | - Thomas Volken
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Holbro
- Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland; Division of Hematology, University Hospital Basel, Switzerland
| | - Laura Infanti
- Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland; Division of Hematology, University Hospital Basel, Switzerland
| | - Jörg P Halter
- Division of Hematology, University Hospital Basel, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel
| | - Caroline Wehmeier
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel
| | - Tamara Diesch
- Division of Hematology /Oncology, University Children's Hospital Basel, Switzerland
| | - Alicia Rovó
- Division of Hematology, University Hospital Bern, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Switzerland
| | - Andreas Buser
- Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland; Division of Hematology, University Hospital Basel, Switzerland
| | - Beatrice Drexler
- Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland; Division of Hematology, University Hospital Basel, Switzerland.
| |
Collapse
|
8
|
Chu YH, Rose WN, Nawrot W, Raife TJ. Pooled platelet concentrates provide a small benefit over single-donor platelets for patients with platelet refractoriness of any etiology. J Int Med Res 2021; 49:3000605211016748. [PMID: 34013757 PMCID: PMC8142527 DOI: 10.1177/03000605211016748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background At our institution, patients with platelet refractoriness (of any etiology) are sometimes switched from apheresis platelets to pooled platelets before human leukocyte antigen (HLA)-matched units become available. Study design and methods Seven patients were analyzed. Platelet counts were available from 57 single-unit transfusions (26 pooled, 31 apheresis). A mixed linear effects model was used and significance was determined using a likelihood ratio test. Results When analyzed as the only fixed effect in the model, the use of pooled versus single-donor units and time from transfusion to post-transfusion blood sampling each showed a significant effect on platelet count increments. A mixed linear effect model including both factors showed that transfusing a pooled unit correlated with a 4500±2000/µL greater platelet count increment compared with a single-donor unit, and an increase in time from transfusion to post-transfusion blood sampling lowered the platelet count increment by 300±100/µL per hour. Conclusion A small but potentially clinically relevant benefit was observed in transfusing pooled random-donor platelets compared with single-donor units for patients with platelet refractoriness (of any etiology).
Collapse
Affiliation(s)
- Ying-Hsia Chu
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - William Nicholas Rose
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - William Nawrot
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Thomas J Raife
- Department of Pathology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| |
Collapse
|
9
|
An epitope-based approach of HLA-matched platelets for transfusion: a noninferiority crossover randomized trial. Blood 2021; 137:310-322. [PMID: 33475737 DOI: 10.1182/blood.2020007199] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
Platelet transfusion refractoriness results in adverse outcomes and increased health care costs. Managing refractoriness resulting from HLA alloimmunization necessitates the use of HLA antigen-matched platelets but requires a large platelet donor pool and does not guarantee full matching. We report the first randomized, double-blind, noninferiority, crossover trial comparing HLA epitope-matched (HEM) platelets with HLA standard antigen-matched (HSM) platelet transfusions. Alloimmunized, platelet-refractory, thrombocytopenic patients with aplastic anemia, myelodysplastic syndrome, or acute myeloid leukemia were eligible. HEM platelets were selected using HLAMatchMaker epitope (specifically eplet) matching. Patients received up to 8 prophylactic HEM and HSM transfusions provided in random order. The primary outcome was 1-hour posttransfusion platelet count increment (PCI). Forty-nine patients were randomized at 14 UK hospitals. For intention to treat, numbers of evaluable transfusions were 107 and 112 for HEM and HSM methods, respectively. Unadjusted mean PCIs for HEM and HSM methods were 23.9 (standard deviation [SD], 15) and 23.5 (SD, 14.1), respectively (adjusted mean difference, -0.1; 95% confidence interval [CI], -2.9 to 2.8). Because the lower limit of the 95% CI was not greater than the predefined noninferiority limit, the HEM approach was declared noninferior to the HSM approach. There were no differences in secondary outcomes of platelet counts, transfusion requirements, and bleeding events. Adequate 1-hour PCI was more frequently observed, with a mean number of 3.2 epitope mismatches, compared with 5.5 epitope mismatches for inadequate 1-hour increments. For every additional epitope mismatch, the likelihood of an adequate PCI decreased by 15%. Epitope-matched platelets should be considered to support HLA alloimmunized patients. This trial was registered at www.isrctn.com as #ISRCTN23996532.
Collapse
|
10
|
Furlong E, Carter T. Aplastic anaemia: Current concepts in diagnosis and management. J Paediatr Child Health 2020; 56:1023-1028. [PMID: 32619069 DOI: 10.1111/jpc.14996] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 12/26/2022]
Abstract
Aplastic anaemia is a rare, previously fatal condition with a significantly improved survival rate owing to advances in understanding of the pathophysiology and improved treatment strategies including haematopoietic stem cell transplantation. Although a rare condition, aplastic anaemia continues to present a high burden for affected patients, their families and the health system due to the prolonged course of disease often associated with high morbidity and the uncertainty regarding clinical outcome. Modern molecular and genetic techniques including next-generation sequencing have contributed to a better understanding of this heterogeneous group of conditions, albeit at a cost of increased complexity of clinical decision-making regarding prognosis and choice of treatment for individual patients. Here we present a concise and comprehensive review of aplastic anaemia and closely related conditions based on extensive literature review and long-standing clinical experience. The review takes the reader across the complex pathophysiology consisting of three main causative mechanisms of bone marrow destruction resulting in aplastic anaemia: direct injury, immune mediated and bone marrow failure related including inherited and clonal disorders. A comprehensive diagnostic algorithm is presented and an up-to-date therapeutic approach to acquired immune aplastic anaemia, the most represented type of aplastic anaemia, is described. Overall, the aim of the review is to provide paediatricians with an update of this rare, heterogeneous and continuously evolving condition.
Collapse
Affiliation(s)
- Eliska Furlong
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Tina Carter
- Department of Paediatric and Adolescent Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Paediatric and Adolescent Haematology Service, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| |
Collapse
|
11
|
Dahl J, Skogen B, Kjaer M, Husebekk A, Kjeldsen-Kragh J, Tiller H. A combined effect of anti-HPA-1a and anti-HLA Class I in pregnancy? Transfusion 2020; 60:2121-2129. [PMID: 32608103 DOI: 10.1111/trf.15944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Maternal anti-human leukocyte antigen (HLA) Class I is commonly detected alongside anti-human platelet antigen (HPA)-1a in fetal and neonatal alloimmune thrombocytopenia (FNAIT). Little is known regarding whether the presence of anti-HLA Class I may exert an additive effect on the risk and severity of FNAIT. METHODS AND MATERIALS We reanalyzed samples originally collected as part of a large Norwegian screening study on FNAIT during 1995-2004. This study identified and managed 170 pregnancies where the mother was HPA-1a negative and had detectable anti-HPA-1a during pregnancy. Maternal samples from 166 of these pregnancies were rescreened for anti-HLA Class I, revealing 111 (67%) that were antibody positive. Various regression models were used to assess if and how maternal anti-HLA Class I influenced the neonatal platelet count. RESULTS AND CONCLUSIONS Unadjusted neonatal platelet counts and the frequency of neonatal thrombocytopenia was not significantly affected by the presence of anti-HLA Class I alongside anti-HPA-1a, but results from regression analyses revealed a possible increased risk when the mother was nulliparous. These results warrant further investigation.
Collapse
Affiliation(s)
- Jesper Dahl
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Skogen
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mette Kjaer
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Centre for Medicine, Clinical Research and Integrated Care, Finnmark Hospital Trust, Hammerfest, Norway
| | - Anne Husebekk
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Kjeldsen-Kragh
- Department of Laboratory Medicine Diagnostic Clinic, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Immunology and Transfusion Medicine, University and Regional Laboratories Region Skåne, Lund, Sweden
| | - Heidi Tiller
- Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
12
|
Rajadhyaksha BS, Desai DP, Navkudkar AA. Platelet refractoriness. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_45_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Choe H, Gergis U, Hsu J, Phillips A, Shore T, Christos P, van Besien K, Mayer S. Bortezomib and Immune Globulin Have Limited Effects on Donor-Specific HLA Antibodies in Haploidentical Cord Blood Stem Cell Transplantation: Detrimental Effect of Persistent Haploidentical Donor-Specific HLA Antibodies. Biol Blood Marrow Transplant 2018; 25:e60-e64. [PMID: 30661542 DOI: 10.1016/j.bbmt.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
Donor-specific HLA antibodies (DSAs) have been associated with an increased risk of graft failure. To decrease DSA levels and reduce the risk of graft failure in haploidentical cord blood transplantation recipients, we studied the effect of bortezomib (BTZ) and i.v. immune globulin (IVIG) pretransplantation. Between 2012 and 2016, 14 patients with a DSA level >2000 mean fluorescence intensity (MFI) to 1 or more mismatched HLA alleles of haploidentical donors, cord blood donors, or both were treated with BTZ and IVIG. Fourteen patients received a median of 4 doses (range, 2 to 8 doses) of BTZ 1.3 mg/m2 and a median total IVIG of 2 g/kg before transplantation. Only 2 of 14 patients attained a reduction in MFI to <2000 with this combination. After additional IVIG (n = 8), rituximab (n = 4), and/or plasmapheresis (n = 11), 12 of 14 patients were desensitized to a DSA level <2000 MFI at the time of engraftment. All obtained initial hematopoietic reconstitution, and no DSA rebound phenomenon was observed. Responders with DSA MFI <2000 to the haploidentical donor by transplantation engrafted at a rate comparable to that of historical controls, whereas engraftment in nonresponders took 3 times as long. BTZ and IVIG alone do not appear sufficient to rapidly induce DSA desensitization, and persistent DSAs to a haploidentical donor lead to delayed count recovery. Our data suggest that additional pretreatment with BTZ and IVIG in combination with the conditioning regimen may help abrogate the rebound phenomenon observed with plasmapheresis.
Collapse
Affiliation(s)
- Hannah Choe
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Moncharmont P. Platelet component transfusion and alloimmunization: Where do we stand? Transfus Clin Biol 2018; 25:172-178. [PMID: 29478960 DOI: 10.1016/j.tracli.2018.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
Platelet transfusion in patients, particularly in onco-haematology, is frequent and can become chronic in some cases. Post-transfusion alloimmunization is often seen, in practice. The risk of this is significantly improved in multitransfused patients. Several classes of antigens binding on platelets (HLA and HPA) are involved and also red blood cell antigens (residual red blood cells in platelet concentrates). Platelet alloimmunization causes a poor transfusion response, refractoriness and, more rarely, post-transfusion purpura. In an alloimmunized recipient, the efficiency of platelet transfusion is based on the selection of compatible products. Significant technical progress means that several methods are currently available to ensure a good post-transfusion platelet count and a satisfactory clinical outcome for the patient.
Collapse
Affiliation(s)
- P Moncharmont
- Hémovigilance, département des vigilances, site de Décines, Établissement français du sang Auvergne-Rhône-Alpes, 111, rue Élisée-Reclus CS 20617, 69153 Décines-Charpieu cedex, France.
| |
Collapse
|
15
|
Takahashi D, Fujihara M, Miyazaki T, Matsubayashi K, Sato S, Azuma H, Kato T, Kino S, Ikeda H, Takamoto S, Sato N, Torigoe T. Flow cytometric quantitation of platelet phagocytosis by monocytes using a pH-sensitive dye, pHrodo-SE. J Immunol Methods 2017; 447:57-64. [PMID: 28472622 DOI: 10.1016/j.jim.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
Abstract
Antibody-mediated phagocytosis of platelets using a flow cytometric monocyte-based phagocytosis assay (FMPA) has been shown to predict the outcome of platelet transfusion. The easy adherence between platelets and monocytes even in the absence of an antibody is regarded as one of limitations of the FMPA. To improve the FMPA for prediction of transfusion outcome, we used the pH-sensitive dye pHrodo succinimidyl ester (pHrodo-SE), which has weak fluorescence at neutral pH and has increased fluorescence intensity in low pH conditions such as in lysomes. Platelets stained with pHrodo-SE were sensitized with an HLA class I monoclonal antibody (w6/32 clone) or anti-HLA class I containing antisera. The platelets were incubated with monocyte-enriched mononuclear cells. Phagocytic activity was assessed by the percentage of monocytes that phagocytosed platelets. Sensitization of platelets with w6/32 significantly increased platelet phagocytosis by monocytes in dose- and time-dependent manners. Anti-HLA class I antibody-containing sera caused platelet phagocytosis in a cognate antigen-antibody-dependent manner. There was a significant correlation (r=0.69, p<0.01) between phagocytic index and titer of HLA class I antibody measured by lymphocyte immunofluorescence test-flow cytometry. In addition, the phagocytic index obtained by FMPA with pHrodo-SE was significantly higher than that obtained by FMPA with the previously used dye, carboxyfluorescein diacetate succinimidyl ester, when platelets were sensitized by w6/32 and anti-HLA class I antibody-containing sera. Because of the higher resolution and higher sensitivity than those of the previous method, the pHrodo-SE-based FMPA may be suitable for more precise quantitation of phagocytosis activity, which would enable qualitative evaluation of transfusion effectiveness.
Collapse
Affiliation(s)
| | | | - Toru Miyazaki
- Japanese Red Cross, Hokkaido Block Blood Center, Japan
| | | | | | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Toshiaki Kato
- Japanese Red Cross, Hokkaido Block Blood Center, Japan
| | - Shuichi Kino
- Japanese Red Cross, Hokkaido Block Blood Center, Japan
| | - Hisami Ikeda
- Japanese Red Cross, Hokkaido Block Blood Center, Japan
| | | | - Noriyuki Sato
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | | |
Collapse
|
16
|
Research Progress of Platelet Transfusion in China. Transfus Med Rev 2017; 31:113-117. [DOI: 10.1016/j.tmrv.2016.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 11/24/2022]
|
17
|
Stanworth SJ, Navarrete C, Estcourt L, Marsh J. Platelet refractoriness--practical approaches and ongoing dilemmas in patient management. Br J Haematol 2015. [PMID: 26194869 DOI: 10.1111/bjh.13597] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Platelet refractoriness can represent a significant clinical problem that complicates the provision of platelet transfusions, is associated with adverse clinical outcomes and increases health care costs. Although it is most frequently due to non-immune platelet consumption, immunological factors are also often involved. Human leucocyte antigen (HLA) alloimmunization is the most important immune cause. Despite the fact that systematic reviews of the clinical studies evaluating different techniques for selecting HLA compatible platelets have not been powered to demonstrate improved clinical outcomes, platelet refractoriness is currently managed by the provision of HLA-matched or cross matched platelets. This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on-going dilemmas and knowledge gaps.
Collapse
Affiliation(s)
- Simon J Stanworth
- Department of Haematology, NHS Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, UK.,International Collaboration for Transfusion Medicine Guidelines (ICTMG), Oxford, UK
| | - Cristina Navarrete
- Histocompatibility & Immunogenetics, NHSBT/Division of Infection & Immunity, University College London, London, UK
| | - Lise Estcourt
- Department of Haematology, NHS Blood and Transplant, Oxford, UK
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| |
Collapse
|
18
|
Kumawat V, Sharma RR, Malhotra P, Marwaha N. Prevalence of risk factors for platelet transfusion refractoriness in multitransfused hemato-oncological patients at tertiary care center in North India. Asian J Transfus Sci 2015; 9:61-4. [PMID: 25722575 PMCID: PMC4339935 DOI: 10.4103/0973-6247.150953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: This study was designed to determine the prevalence and assess the risk factors responsible for platelet transfusion refractoriness in hemato-oncological patients. Materials and Methods: The study included 30 patients. Twelve were clinically diagnosed as aplastic anemia and the 18 were of acute myeloid leukemia. A prospective 3 months follow-up was planned to monitor the response of platelet transfusion therapy, based on their posttransfusion corrected count increment at 1st and 24th h. Based on the observations, patients were categorized into refractory and nonrefractory groups. Common nonimmunological causes such as fever, sepsis, bleeding, disseminated intravascular coagulation, chemotherapy, splenomegaly, ABO mismatch, and antithymocyte globulin therapy were monitored. Among the immunological causes, presence of antihuman leukocyte antigen (HLA) class I antibodies and platelet glycoprotein antibodies in patient's serum were monitored. Results: During the study period, 17 (56.66%) patients did not show desired platelet count increment. Transfusion requirements of refractory group for both red cell and platelet product were significantly higher (P < 0.05) in comparison to nonrefractory group. Among immunological causes, anti HLA class I antibodies (P < 0.013), antihuman platelet antigen-5b antibodies (P < 0.033) were significantly associated with refractoriness. Among nonimmunological causes, bleeding (P < 0.019, odd ratio 8.7), fever (P < 0.08, odd ratio 5.2), and infection (P < 0.07, odd ratio 5.4) were found to associated with refractoriness. Conclusion: Platelet refractoriness should be suspected in multitransfused patients not showing expected increment in platelet counts and thoroughly investigated to frame further guidelines in order to ensure proper management of these kind of patients.
Collapse
Affiliation(s)
- Vijay Kumawat
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
19
|
Duquesnoy RJ, Marrari M, Mulder A, Sousa LCDDM, da Silva AS, do Monte SJH. First report on the antibody verification of HLA-ABC epitopes recorded in the website-based HLA Epitope Registry. ACTA ACUST UNITED AC 2015; 83:391-400. [PMID: 24828056 DOI: 10.1111/tan.12341] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/01/2014] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
Abstract
The International Registry of Antibody-Defined HLA Epitopes ( http://www.epregistry.com.br) has been recently established as a tool to understand humoral responses to human leukocyte antigen (HLA) mismatches. These epitopes are defined structurally by three-dimensional molecular modeling and amino acid sequence differences between HLA antigens. So-called eplets represent essential components of HLA epitopes and they are defined by polymorphic residues. A major goal is to identify HLA epitopes that have been verified experimentally with informative antibodies. Our analysis has also included data in many publications. As of 1 November 2013, 95 HLA-ABC antibody-verified epitopes have been recorded, 62 correspond to eplets and 33 are defined by eplets paired with other residue configurations. The Registry is still a work-in-progress and will become a useful resource for HLA professionals interested in histocompatibility testing at the epitope level and investigating antibody responses to HLA mismatches in transplant patients.
Collapse
Affiliation(s)
- R J Duquesnoy
- Division of Transplant Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | | |
Collapse
|
20
|
Dettori I, Ladaique P. [Managing of platelet transfusion refractoriness of haematological malignancies. Experience IPC-EFSAM]. Transfus Clin Biol 2014; 21:207-9. [PMID: 25267204 DOI: 10.1016/j.tracli.2014.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/30/2022]
Abstract
The platelet refractoriness is a complication of transfusion treatments potentially dramatic in onco-haematology. Chemo-treatment of haematological malignancies or packs of allogeneic bone marrow transplants require iterative platelet transfusion requirements. The discovery of a platelet refractoriness along with its support should be the most reactive as possible but also adapted to the cause. In the case of allo-immunization, it may be expected. The purpose of this presentation is to recall the different etiologies and perform a feedback on the support transfusion platelet of onco-haematology adult patients at Institut Paoli-Calmettes (IPC) in partnership with the EFSAM.
Collapse
Affiliation(s)
- I Dettori
- Établissement français du sang Alpes-Méditerranée (EFSAM), 149, boulevard Baille, 13992 Marseille cedex 05, France
| | - P Ladaique
- Centre de lutte contre le cancer, Institut Paoli-Calmettes (IPC), cellule d'hémovigilance, 232, boulevard Sainte-Marguerite, 13009 Marseille, France.
| |
Collapse
|
21
|
Abstract
Adolescent and young adult patient presentations of aplastic anemia require a particular perspective on both diagnosis and treatment. This unique age group necessitates a thorough diagnostic evaluation to ensure the etiology, acquired or inherited, is sufficiently determined. The treatment options include human leukocyte antigen-identical sibling hematopoietic cell transplantation or immunosuppressive therapy, and both require attention to the specific medical and social needs of these adolescents and young adults. Longitudinal surveillance throughout life for the development of late complications of the disease and treatment is mandatory.
Collapse
Affiliation(s)
- Amy E DeZern
- Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | | |
Collapse
|
22
|
Xu LH, Fang JP, Weng WJ, Xu HG. Critical role of sensitized serum in rejection of allogeneic bone marrow cells. Turk J Haematol 2014; 31:266-71. [PMID: 25330519 PMCID: PMC4287027 DOI: 10.4274/tjh.2012.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Humoral immunity has been clearly implicated in solid organ transplantation, but little is known about the relationship between humoral immunity and hematopoietic stem cell transplantation. This study was designed to investigate that relationship. Materials and Methods: Sensitized serum was obtained from a sensitized murine model established by allogeneic splenocyte transfusion. Sensitized serum was incubated with allogeneic bone marrow cells (BMCs) in vitro and the cytotoxicity was evaluated by the complement-dependent cytotoxicity method. Mice were transplanted with allogeneic BMCs incubated with sensitized serum after lethal irradiation. The engraftment was assayed by hematopoietic recovery and chimera analysis. Moreover, mice received passive transfer of sensitized serum 1 day prior to transplantation. Mortality was scored daily after bone marrow transplantation. Results: The in vitro experiments showed that sensitized serum was capable of impairing allogeneic BMCs through the complement-dependent cytotoxicity pathway. The animal studies showed that BMCs incubated with sensitized serum failed to rescue mice from lethal irradiation. The engraftment assay showed that the allogeneic BMCs incubated with sensitized serum were rejected with time in the recipients. Furthermore, the mice died of marrow graft rejection by transfer of sensitized serum prior to transplantation. Conclusion: Taken together, our results indicated that sensitized serum played a critical role in graft rejection during hematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Lu-Hong Xu
- Sun Yat-sen University, Sun Yat-sen Memorial Hospital, Department of Pediatrics, Guangzhou, China. E-ma-il:
| | | | | | | |
Collapse
|
23
|
Agarwal N, Chatterjee K, Sen A, Kumar P. Prevalence of platelet reactive antibodies in patient's refractory to platelet transfusions. Asian J Transfus Sci 2014; 8:126-7. [PMID: 25161354 PMCID: PMC4140056 DOI: 10.4103/0973-6247.137453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction & Aims: Though platelet transfusions have greatly reduced the incidence of major haemorrhagic complications associated with the management of haematological and oncological disorders, refractoriness to infused platelets becomes a major clinical problem for many of these patients. Materials and methods: The present study was done to determine the percentage of platelet alloimmunisation due to platelet-reactive antibodies in 340 patients with hematologic or oncologic diseases who had received multiple transfusions (> 10) of blood and blood components and showed platelet refractoriness in 1-hour post transfusion sample. Results: Platelet-reactive antibodies were detected in the sera of 127 out of 340 patients (37.35%) who received multiple transfusions (> 10) and showed platelet refractoriness. Conclusion: Platelet-reactive antibodies appear to be an important cause of platelet refractoriness in patients of acute leukaemia, aplastic anaemia, NHL, MDS and multiple myeloma receiving multiple platelet transfusions. Platelet refractoriness in patients of ITP and chronic leukaemia appears to be due to other causes and not due to platelet-reactive antibodies.
Collapse
Affiliation(s)
- Nitin Agarwal
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kabita Chatterjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Sen
- Armed Force Transfusion Centre, New Delhi, India
| | - Praveen Kumar
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
24
|
Rioux-Massé B, Cohn C, Lindgren B, Pulkrabek S, McCullough J. Utilization of cross-matched or HLA-matched platelets for patients refractory to platelet transfusion. Transfusion 2014; 54:3080-7. [PMID: 24916382 DOI: 10.1111/trf.12739] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Use of cross matching or HLA matching for donor selection is the basis of managing patients refractory to platelet (PLT) transfusion. Because of changes in patient care, we evaluated the effect of cross matching and HLA matching in patients refractory to PLT transfusion. STUDY DESIGN AND METHODS We identified all patients who received either HLA-matched or cross-matched PLTs during a 3-year period at our medical center. Patient records were reviewed and laboratory data were collected. One- to 4-hour corrected count increments (CCIs) were calculated for transfusions given up to 72 hours before receiving these specialized units and the HLA-matched or cross-matched units themselves. RESULTS Thirty-two patients were identified who received a total of 354 PLT transfusions. Of these, 161 were from unselected apheresis, 152 were cross matched, and 41 were HLA selected. The median CCI for random-donor transfusions was 0 (range, 0 × 10(9)-10.5 × 10(9)/L), for cross-matched PLT transfusions 1.7 × 10(9)/L (0 × 10(9)-5.1 × 10(9)/L), and for HLA-matched transfusions 1.2 × 10(9)/L (0 × 10(9)-13.9 × 10(9)/L). Only 25 and 30% of cross-match-compatible or HLA-selected units, respectively, gave 1- to 4-hour CCIs of more than 5.0 × 10(9)/L compared to 12% of the transfusions from random donors. There were no significant differences in the 1- to 4-hour CCIs when comparing random units with HLA-selected or cross-match-compatible units. There was also no significant difference when comparing the HLA-matched and cross-match-compatible PLT units with each other. CONCLUSIONS The use of cross-match-compatible or HLA-matched units did not provide better increments in PLT count when compared to random nonselected units. Clinical factors may overpower immunologic matching.
Collapse
|
25
|
Sarkar RS, Philip J, Jain N. Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients. Indian J Hematol Blood Transfus 2014; 31:77-84. [PMID: 25548450 DOI: 10.1007/s12288-014-0374-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/15/2014] [Indexed: 10/25/2022] Open
Abstract
Platelets express glycoproteins (IIb/IIIa, Ib/IX, Ia/IIa, IV, and HLA-1) that are polymorphic and can become targets for antibody responses. Patients at threat are those who received multiple platelet transfusions. Modified antigen capture elisa (MACE) is a qualitative solid phase Elisa designed to detect IgG antibodies against platelet specific antigens. The study has been carried out over a period of 2 years. A total of 100 patients were selected, who had been transfused with at least 15 units of platelet concentrate. All patients were having either hematological malignancies or bone marrow failure syndromes. Platelet antibodies were identified using MACE-1&2. Data was analysed statistically, using odds ratio (OR) with 95 % confidence interval. 39 % of the patients were found to be alloimmunized against platelet antigens, of which eleven showed refractoriness. Six patients (54.5 %) with HLA-1, two patients (9.5 %) with GPIb/IX, two patients (40 %) with both HLA-1 and GPIIb/IIIa, and one patient with GPIIb/IIIa antibodies showed refractoriness. Production of HLA-1 antibody and the development of refractoriness was found to be significant with OR 14.05 and P value 0.0025. MACE-1&2 enabled specific detection and identification of platelet antibodies, which in turn correlated well with the development of refractoriness in multi transfused patients. GPIb/IX was detected as the commonest antibody in our patient population, which is in variance with Europian studies where it is GPIa/IIIa (HPA-1a/5b). This technique should be utilised in patients who are at an increased risk of developing alloimmunisation due to repeated platelet transfusions.
Collapse
Affiliation(s)
- R S Sarkar
- Department of Immunohaematology and Blood Transfusion, Armed Forces Medical College, Pune, 411040 India
| | - J Philip
- Department of Immunohaematology and Blood Transfusion, Armed Forces Medical College, Pune, 411040 India
| | - Neelesh Jain
- Department of Transfusion Medicine, Tata Medical Centre, Kolkata, 700156 India
| |
Collapse
|
26
|
Patel SR, Zimring JC. Transfusion-induced bone marrow transplant rejection due to minor histocompatibility antigens. Transfus Med Rev 2013; 27:241-8. [PMID: 24090731 DOI: 10.1016/j.tmrv.2013.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 08/15/2013] [Accepted: 08/17/2013] [Indexed: 11/18/2022]
Abstract
Traditionally, alloimmunization to transfused blood products has focused exclusively on recipient antibodies recognizing donor alloantigens present on the cell surface. Accordingly, the immunologic sequelae of alloimmunization have been antibody mediated effects (ie, hemolytic transfusion reactions, platelet refractoriness, anti-HLA and anti-HNA effects, etc). However, in addition to the above sequelae, there is also a correlation between the number of antecedent transfusions in humans and the rate of bone marrow transplant (BMT) rejection-under reduced intensity conditioning with HLA-matched or HLA-identical marrow. Bone marrow transplant of this nature is the only existing cure for a series of nonmalignant hematologic diseases (eg, sickle cell disease, thalassemias, etc); however, rejection remains a clinical problem. It has been hypothesized that transfusion induces subsequent BMT rejection through immunization. Studies in animal models have observed the same effect and have demonstrated that transfusion-induced BMT rejection can occur in response to alloimmunization. However, unlike traditional antibody responses, sensitization in this case results in cellular immune effects, involving populations such as T cell or natural killer cells. In this case, rejection occurs in the absence of alloantibodies and would not be detected by existing immune-hematologic methods. We review human and animal studies in light of the hypothesis that, for distinct clinical populations, enhanced rejection of BMT may be an unappreciated adverse consequence of transfusion, which current blood bank methodologies are unable to detect.
Collapse
Affiliation(s)
- Seema R Patel
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | |
Collapse
|
27
|
Enein AAA, Desoukey NAE, Hussein EAW, Hamdi M, Jamjom NA. HLA alloimmunization in Egyptian aplastic anemia patients receiving exclusively leukoreduced blood components. Transfus Apher Sci 2013; 48:213-8. [DOI: 10.1016/j.transci.2012.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 08/21/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
|
28
|
|
29
|
Massey E, Harding K, Kahan BC, Llewelyn C, Wynn R, Moppett J, Robinson SP, Green A, Lucas G, Sadani D, Liakopoulou E, Bolton-Maggs P, Marks DI, Stanworth S. The granulocytes in neutropenia 1 (GIN 1) study: a safety study of granulocytes collected from whole blood and stored in additive solution and plasma. Transfus Med 2012; 22:277-84. [PMID: 22591484 DOI: 10.1111/j.1365-3148.2012.01152.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/AIM To evaluate the safety of transfusing pooled, whole blood-derived granulocytes in additive solution and plasma (GASP) in 30 recipients. BACKGROUND Demand for granulocytes in England has increased five-fold. With the advantages of reduced red cell, plasma and overall volume, GASP maintains function in vitro. METHODS AND MATERIALS Observations were recorded prior to and post transfusion. Increments were recorded at 1 h and the following morning. Leucocyte antibody screening was undertaken prior to and at 1-6 months following transfusion. RESULTS Thirty patients aged between 8 months and 68 years received 221 GASP in 148 transfusion episodes. GASP contained an average of 1.0 × 10(10) granulocytes in 207 mL. Adults usually received two packs and children 10-20 mL kg(-1). Children and adults received a median [interquartile range (IQR)] dose of 12.5 (9.1-25.3) and 19.7 (12.0-25.8) × 10(9) granulocytes per transfusion, respectively. There was one episode of transfusion-associated circulatory overload (TACO) in a patient with chronic cardiac failure following 600 mL of unpooled granulocytes, other fluids and one GASP. New leucocyte alloimmunisation occurred in 3/30 recipients 10%. No other significant reactions were reported. Median peripheral blood neutrophil increments at 1 h post transfusion were 0.06 (IQR, 0.01-0.17) in children and (0.03) (IQR, 0-0.16) in adults. CONCLUSION GASP has a similar safety profile to other sources of granulocytes for patients with refractory infection or in need of secondary prophylactic transfusion. Further studies are required to clarify the role of GASP in the treatment of neutropenic patients.
Collapse
Affiliation(s)
- Edwin Massey
- NHS Blood and Transplant, North Bristol Park, Northway Filton, Bristol BS34 7QH, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Acquired aplastic anemia is a potentially fatal bone marrow failure disorder that is characterized by pancytopenia and a hypocellular bone marrow. Hematopoietic stem-cell transplantation or bone marrow transplantation (BMT) is the treatment of choice for young patients who have a matched sibling donor. Immunosuppression with either anti-thymocyte globulin and cyclosporine or high-dose cyclophosphamide is an effective therapy for patients who are not suitable BMT candidates owing to age or lack of a suitable donor. Results of BMT from unrelated and mismatched donors are improving, but presently this treatment option is best reserved for those patients who do not respond, relapse or develop secondary clonal disorders following immunosuppressive therapy. Efforts are currently underway to both improve immunosuppressive regimens and to expand the application of BMT.
Collapse
Affiliation(s)
- Amy E Dezern
- Division of Medical Oncology, Department of Medicine, The Johns Hopkins School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205, USA
| | | |
Collapse
|
31
|
Sayed D, Bakry R, El-Sharkawy N, Zahran A, Khalaf MR. Flow cytometric platelet cross-matching to predict platelet transfusion in acute leukemia. J Clin Apher 2010; 26:23-8. [DOI: 10.1002/jca.20273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 09/29/2010] [Indexed: 11/12/2022]
|
32
|
Pai SC, Lo SC, Lin Tsai SJ, Chang JS, Lin DT, Lin KS, Lin LI. Epitope-based matching for HLA-alloimmunized platelet refractoriness in patients with hematologic diseases. Transfusion 2010; 50:2318-27. [DOI: 10.1111/j.1537-2995.2010.02703.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
33
|
Marsh J, Socie G, Tichelli A, Schrezenmeier H, Hochsmann B, Risitano AM, Fuehrer M, Bekassy AN, Korthof ET, Locasciulli A, Ljungman P, Bacigalupo A, Camitta B, Young NS, Passweg J. Should irradiated blood products be given routinely to all patients with aplastic anaemia undergoing immunosuppressive therapy with antithymocyte globulin (ATG)? A survey from the European Group for Blood and Marrow Transplantation Severe Aplastic Anaemia Working Party. Br J Haematol 2010; 150:377-9. [PMID: 20528874 PMCID: PMC3521531 DOI: 10.1111/j.1365-2141.2010.08200.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Figueiredo C, Goudeva L, Horn PA, Eiz-Vesper B, Blasczyk R, Seltsam A. Generation of HLA-deficient platelets from hematopoietic progenitor cells. Transfusion 2010; 50:1690-701. [DOI: 10.1111/j.1537-2995.2010.02644.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
|
36
|
Duquesnoy RJ. Structural epitope matching for HLA-alloimmunized thrombocytopenic patients: a new strategy to provide more effective platelet transfusion support? Transfusion 2007; 48:221-7. [PMID: 18005328 DOI: 10.1111/j.1537-2995.2007.01516.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the past three decades, HLA matching for platelet (PLT) transfusion of refractory thrombocytopenic patients has been based on serologic cross-reactivity between HLA-A and HLA-B antigens. Although many blood banks are using this matching strategy, the general experience is that such matched PLT transfusions are often ineffective. STUDY DESIGN AND METHODS This report describes a new HLA matching algorithm that considers structurally defined epitopes recognized by antibodies. HLAMatchmaker is a computer program that determines histocompatibility at the amino acid level initially designed as triplets (i.e., linear sequences of three residues in molecular surface-exposed positions) but now updated as eplets representing patches of antibody-accessible polymorphic residues surrounded by residues within a 3-A radius. The eplet version of HLAMatchmaker is also useful in the analysis of HLA antibody reactivity patterns of alloimmunized patients so that acceptable mismatches can be identified. CONCLUSION An HLA epitope-based matching protocol is proposed that may permit a more effective PLT transfusion management of refractory patients. This protocol includes high-resolution HLA-A, -B, and -C typing of patients and donors, serum screening to identify acceptable mismatches, and the identification of suitable donors in a donor database that incorporates HLAMatchmaker as a search engine. HLAMatchmaker programs can be downloaded from the Web site http://tpis.upmc.edu/tpis/HLAMatchmaker/.
Collapse
Affiliation(s)
- Rene J Duquesnoy
- Division of Transplantation Pathology, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA.
| |
Collapse
|
37
|
Vassallo RR. New paradigms in the management of alloimmune refractoriness to platelet transfusions. Curr Opin Hematol 2007; 14:655-63. [PMID: 17898571 DOI: 10.1097/moh.0b013e3282eec526] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Following transfusion or pregnancy, a significant number of patients develop antibodies to class I human leukocyte antigen. Some will exhibit platelet transfusion refractoriness, defined as inappropriately low platelet count increments after two or more consecutive transfusions. Unfortunately, failure of at least two products is required before an immunologic work-up is undertaken. Among those diagnosed with immune refractoriness, there is no standard method for identifying platelet products likely to be effective. RECENT FINDINGS Recent advances in detection and identification of human leukocyte antigen antibody may permit pretransfusion screening of selected patients and provide guidance in choosing the optimal product. An approach more like that for red cell alloimmunized patients, in which one provides products guided solely by the antibody profile, is preferable to selection based on educated guesswork when human leukocyte antigen identical units are unavailable, and offers some advantages over platelet crossmatching. SUMMARY This review presents a literature-based algorithm with which to approach the management of platelet refractory individuals, focusing on newer technology to maximize the post-transfusion yield of matched units. Strategies are presented that allow selection of more effective products for difficult, broadly alloimmunized individuals, including patients who have developed antibodies to human platelet antigens.
Collapse
Affiliation(s)
- Ralph R Vassallo
- University of Pennsylvania School of Medicine and American Red Cross Blood Services Heritage Division, Penn-Jersey Region, Philadelphia, Pennsylvania 19123, USA.
| |
Collapse
|
38
|
Abstract
Ever since platelet transfusions were shown to reduce mortality from haemorrhage in patients with acute leukaemia in the 1950s, the use of this therapy has steadily grown to become an essential part of the treatment of cancer, haematological malignancies, marrow failure, and haematopoietic stem cell transplantation. Today, more than 1.5 million platelet products are transfused in the USA each year, 2.9 million products in Europe. However, platelet transfusion can transmit infections and trigger serious immune reactions and they can be rendered ineffective by alloimmunisation. There are several types of platelet components and all can be modified to reduce the chances of many of the complications of platelet transfusion. Transfusion practices, including indications for transfusion, dose of platelets transfused, and methods of treating alloimmunised recipients vary between countries, and even within countries. We review commonly used platelet components, product modifications, transfusion practices, and adverse consequences of platelet transfusions.
Collapse
Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1184, USA.
| | | |
Collapse
|